Department of Pediatrics, Division of Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Children's Wisconsin.
Curr Opin Pediatr. 2020 Jun;32(3):428-435. doi: 10.1097/MOP.0000000000000903.
Children with medical or surgical critical illness or injury require skillful attention to physical, emotional, psychological, and spiritual needs, whereas their families need support and guidance in facing life-threatening or life-changing events and gut-wrenching decisions. This article reviews current evidence and best practices for integrating palliative care into the pediatric intensive care unit (PICU), with a focus on surgical patients.
Palliative care is best integrated in a tiered approach, with primary palliative care provided by the PICU and surgical providers for all patients and families, including basic symptom management, high-quality communication, and end-of-life care. Secondary and tertiary levels of care involve unit or team-based 'champions' with additional expertise, and subspecialty palliative care teams, respectively. PICU and surgical providers should be able to provide primary palliative care, to identify patients and families for whom a palliative care consult would be helpful, and should be comfortable introducing the concept of palliative care to families.
This review provides a framework and tools to enable PICU and surgical providers to integrate palliative care best practices into patient and family care.
患有医学或外科重病或损伤的儿童需要熟练关注身体、情感、心理和精神需求，而他们的家人则需要在面对威胁生命或改变生活的事件和令人痛心的决策时得到支持和指导。本文综述了将姑息治疗纳入儿科重症监护病房（PICU）的当前证据和最佳实践，重点关注外科患者。
姑息治疗最好通过分层方法进行整合，由 PICU 和外科医生为所有患者和家属提供初级姑息治疗，包括基本症状管理、高质量沟通和临终关怀。二级和三级护理分别涉及具有额外专业知识的单位或团队“拥护者”和专科姑息治疗团队。PICU 和外科医生应该能够提供初级姑息治疗，识别需要姑息治疗咨询的患者和家属，并能够舒适地向家属介绍姑息治疗的概念。
本综述提供了一个框架和工具，使 PICU 和外科医生能够将姑息治疗的最佳实践纳入患者和家属的护理中。
